Obamacare anew in NY

On the eve of the second enrollment period for Obamacare — which begins November 15 — insurers in the state are not getting what they asked for. During the first six-month enrollment period, which ended officially March 31 of this year but was extended due to website glitches, 370,000 state residents were able to sign up for private health insurance through the Affordable Care Act.

People can sign up for Medicaid at any time during the year. Though not restricted to the enrollment periods, some 600,000 people signed up during the last one, including many who were previously uninsured. This makes nearly a million New Yorkers affected by Obamacare.

The ACA was instituted to control the health insurance industry. There were 44 million uninsured Americans, the highest in history, and the law was designed to require that everyone be insured, with fines to motivate those who didn’t sign up. People who don’t have coverage by 2015 will pay a penalty of $325 per adult, $162.50 per child or two percent of income, whichever is higher. Other factors in the plan include expansion of the Medicaid program and elimination of restrictions on pre-existing conditions.

Each state has its own exchanges or marketplace where lower- or middle-income uninsured people can shop for relatively affordable plans. New York’s offers platinum, gold, silver and bronze options, from most expensive to least with varying levels of coverage.

Some participating insurance companies for New York residents have been trying to raise premiums by 12 to 20 percent, making them not so affordable. Although the state Department of Financial Services nixed those increases, rates will still rise by an average of 5.7 percent, about half the average rate increase requested a few months ago. For example, MVP requested an 18.31 percent hike but was only approved for 9.97 percent. Excellus asked for 19.59 percent but was only approved for 9.23.

Some of the causes cited for the requested rise in rates were a gradual reduction in federal government reinsurance payments, rising prices for medical services and prescription medicines, additional staffing requirements for the insurance companies because of the extra workload from Obamacare, and mandates for mental health and substance abuse coverage.